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Midwifery Dissertation Topics

Published by Owen Ingram at January 3rd, 2023 , Revised On August 16, 2023

There have been midwives around for decades now. The role of midwives has not changed much with the advent of modern medicine, but their core function remains the same – to provide care and comfort to pregnant women during childbirth.

It is possible to be a midwife in the healthcare industry, but it is not always a rewarding or challenging career. Here are five things you didn’t know about midwifery nursing to help you decide if it could be the right career choice for you.

The profession of midwifery involves caring for women and newborns during pregnancy, childbirth, and the first few days following birth. Registered nurses are trained with four additional years of education along with major research on methods involve in midwifery and writing on midwifery dissertation topics, while midwives provide natural health care for mothers and children.

As a midwife, your role is to promote healthy pregnancies and births while respecting women’s rights and dignity. Midwives provide care to patients at every stage of life, from preconception to postpartum, family planning to home delivery to breastfeeding support.

Important Links: Child Health Nursing Dissertation Topics , Adult Nursing Topics , Critical Care Nursing Dissertation Topics . These links will help you to get a broad experience or knowledge about the latest trends and practices in academics.

Midwifery Is A Good Fit for the Following:

● Those who want to work with women, especially those at risk of giving birth in a                    hospital setting. ● Those who enjoy helping people and solving problems. ● Those who like to be creative and solve complex problems. ● Those who want to help others and make a difference in their lives.

Midwifery is a career with many benefits for both the midwife and the baby. They are well-trained and experienced in caring for pregnant women and newborns and often have access to the exceptional care that other nurses may not have.

Related Links:

• Evidence-based Practice Nursing Dissertation Topics
• Child Health Nursing Dissertation Topics
• Adult Nursing Dissertation Topics
• Critical Care Nursing Dissertation Topics
• Dementia Nursing Dissertation Topics
• Palliative Care Nursing Dissertation Topics
• Mental Health Nursing Dissertation Topics
• Nursing Dissertation Topics
• Coronavirus (COVID-19) Nursing Dissertation Topics

Midwifery Dissertation Topics With Research Aim

Topic:1 adolescence care.

Research Aim: Focus on comprehensive medical, psychological, physical, and mental health assessments to provide a better quality of care to patients.

Topic:2 Alcohol Abuse

Reseasrch Aim: Closely studying different addictions and their treatments to break the habit of drug consumption among individuals.

Topic:3 Birth Planning

Research Aim: Comprehensive birth planning between parents discussing the possible consequences of before, between, and after labour.

Topic:4 Community midwifery

Research Aim: Studying different characters in community midwifery and the midwife’s role in providing care for the infant during the early days of the child’s birth.

Topic:5 Contraception

Research Aim: Understand the simplicity of contraception to prevent pregnancy by stopping egg production that results in the fertilization of egg and sperm in the later stages.

Topic:6 Electronic fetal monitoring

Research Aim: In-depth study of electronic fetal monitoring to track the health of your baby during the womb, record construction per minute, and make a count of your baby’s heart rate.

Topic:7 Family planning

Research Aim: Importance to follow the basic rhythm methods for the couple to prevent pregnancy and use protection during the vaginal sex to plan a family without fertility treatments.

Topic:8 Foetal and newborn care

Research Aim: Expansion of the maternal-fetal and newborn care services to improve the nutritional quality of infants after delivery during their postnatal care time.

Topic:9 Foetal well being

Carefully tracking indications for the rise in heart rate of the fetal by weekly checkups to assess the overall well-being of the fetal.

Topic:10 Gender-based violence

Research Aim: Studying the consequences of male desire for a child that results in gender-based violence, harming the child’s physical and mental health.

Topic:11 Health promotion

Research Aim: Working on practices that help in controlling the amount of pollution of people, taking care of their overall health, and improving quality of life through adapting best health practices.

Topic:12 High-risk pregnancy

Research Aim: Calculating the ordinary risks of a high-risk pregnancy and how it affects a pregnant body resulting in a baby with poor health or any by-birth diseases, increasing the chance for complications.

Topic:13 HIV infection

Research Aim: Common causes of HIV infection and their long-term consequences on the body’s immune system. An in-depth study into the acquired immunodeficiency and the results leading to this.

Topic:14 Human Rights

Creating reports on human rights and their link with the freedom of thought, conscience, religion, belief, and other factors.

Topic:15 Infection prevention and control

Research Aim: Practices for infection prevention and control using efficient approaches for patients and health workers to avoid harmful substances in the environment.

Topic:16 Infertility and pregnancy

Research Aim: Evaluating the percentage of infertility and pregnancy, especially those facing no prior births, and who have high chances of infertility and pregnancy complications.

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Midwives are nurses who provide continuous support to the mother before, during, and after labour. Midwives also help with newborn care and educate parents on how to care for their children.

How Much Do Midwives Make?

The salary of a midwife varies depending on the type of work, location, and experience of the midwife. Midwives generally earn $132,950 per year. The average annual salary for entry-level midwives is $102,390.

The minimum requirement for becoming a midwifery nurse is a bachelor’s degree in nursing, with the option of pursuing a master’s degree.

An accredited educational exam can also lead to certification as a nurse-midwife (CNM). The American College of Nurse-Midwives (ACNM) enables you to practice independently as a midwife.

There are many pros and cons to working as a midwife. As a midwife, you have the following pros and cons:

• Midwives have the opportunity to help women during one of the most memorable moments in their lives.
• Midwives can positively impact the health of mothers and their children.
• Midwives can work in many hospitals, clinics, and homes.
• In midwifery, there are many opportunities for continuing education and professional development.
• You will often have to work nights and weekends, which can be mentally draining.
• You will have to travel a lot since most births occur in hospitals or centres in different areas.
• You will have to deal with stressors such as complex patients and uncooperative families.
• You will be dealing with a lot of pain, so you need to be able to handle it without medication or other treatment methods.

A career in midwifery is a great fit for those with a passion for health and wellness, an interest in helping people, and a desire to work in a supportive environment.

It is important to become involved in your local midwifery community if you are contemplating a career in midwifery – the best source of learning is your major research work, along with writing a lengthy thesis document on midwifery dissertation topics that will submit to your university to progress your midwifery career.

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Frequently Asked Questions

How to find midwifery dissertation topics.

To find midwifery dissertation topics:

• Explore childbirth challenges or trends.
• Investigate maternal and infant health.
• Consider cultural or ethical aspects.
• Review recent research in midwifery.
• Focus on gaps in knowledge.
• Choose a topic that resonates with your passion and career goals.

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In this article, we suggest some topics regarding USA’s Withdrawal From Afghanistan so you can kick start your dissertation without any delay.

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Midwifery students’ perceptions and experiences of learning in clinical practice: a qualitative review protocol

Yang, Zhihui 1 ; Li, Xinxin 2 ; Lin, Huanhuan 2 ; Chen, Fanfan 2 ; Zhang, Lili 1 ; Wang, Ning 1

1 PR China Southern Centre for Evidence-based Nursing and Midwifery Practice: A JBI Centre of Excellence, Guangzhou City, Guangdong Province, PR China

2 School of Nursing, Southern Medical University, Guangzhou City, Guangdong Province, PR China

Correspondence: Ning Wang, [email protected]

The authors declare no conflict of interest.

Objective: 

This systematic review aims to investigate and synthesize qualitative evidence related to midwifery students’ perceptions and experiences of learning in clinical practice.

Introduction: 

Midwifery students are required to develop strong competencies during pre-registration education for future practice. Clinical placements provide a good opportunity for students to build essential practice capacities. Understanding the perceptions and experiences of midwifery students in clinical practice helps develop effective midwifery clinical educational strategies. A qualitative systematic review is therefore proposed to improve midwifery clinical education.

Inclusion criteria: 

This proposed review will consider qualitative studies that have explored midwifery students’ perceptions and experiences of learning in clinical practice in all degrees. The search will be limited to English-language published and unpublished studies to the present.

Methods: 

This review will follow the JBI approach for qualitative systematic reviews. A three-stage search will be conducted to include published and unpublished literature. Databases to be searched include PubMed, Science Direct, Web of Science, CINAHL, PsycINFO, American Nurses Association, Google Scholar, ProQuest Dissertation & Theses, and Index to Theses in Great Britain and Ireland. Identified studies will be screened for inclusion in the review by two independent reviewers. Any disagreements will be resolved through discussion. Data will be extracted using a standardized tool. Data synthesis will adhere to the meta-aggregative approach to categorize findings. The categories will be synthesized into a set of findings that can be used to inform midwifery education.

Systematic review registration number: 

PROSPERO CRD42020208189

Introduction

Due to strong advocacy for improved health and safety of pregnant women and their babies globally, many countries have made significant progress in increasing the proportion of pregnant women who give birth at health care facilities. 1 However, such effort has not led to the expected level of reduction in maternal and newborn mortality and stillbirths, 2 which can be caused by inadequacies in the quality of care provided in the health care facilities. 3

The delivery of quality and safe midwifery practice requires that health professionals develop strong competencies and high-level accountabilities. Evidence shows that well educated, regulated, and licensed midwives are associated with improved quality of care and rapid and sustained reduction in maternal or neonatal morbidity and mortality. 4 Pre-registration education is an important stage for midwifery students to develop the fundamental professional knowledge, skills, and judgment essential for their future practice. Clinical practice programs as a significant component of midwifery education provide a valuable opportunity for midwifery students to build hands-on capabilities that integrate with classroom theories, and to be socialized into their chosen profession. 5 Specifically, it helps students develop the required professional competencies for registration and ideas about their career preference, as well as smoothly transit to their future career. 6,7 It has been found that education undertaken through clinical placements provides up to 50% of the learning experience for students in pre-registration midwifery courses. 8

Midwifery refers to “skilled, knowledgeable and compassionate care for childbearing women, newborn infants and families across the continuum throughout pre-pregnancy, pregnancy, birth, postpartum and the early weeks of life.” 9 (p.1130) Midwifery practice involves a wide scope of care activities that are undertaken to pursue the overall well-being of pregnant women. This includes providing continuous support to the women during their antenatal, intrapartum, and postpartum periods, being responsible for conducting births, caring for the newborns, and preventing and managing complications in pregnancy and childbirth. 10 These require that midwives are highly competent in undertaking various work tasks in partnership with the women and to cope with the complex and dynamic nature of the practice environments. 11 To face such challenging learning requirements, midwifery students can become frustrated when they first enter a practice setting. Literature shows that student health professionals often face challenges and experience a high level of stress during their clinical placements, 12,13 and midwifery students experience more stress compared to students in other professions. 14,15 Research has found that the midwifery students’ clinical stress was either due to their low confidence in undertaking care and a fear of making mistakes, or their relationships with clinical educators and colleagues. 16 Negative clinical experiences perceived by the student midwives can pose a potential threat to their effective learning and recognition of their future professional career. 17-19

As a key part of successful midwifery education, a well-designed practice program with a supportive environment is essential for fostering students’ confidence and passion to pursue a future midwifery career and for building competencies for entry to their registrations. 7,20 Students’ perceptions and experiences about their clinical learning are considered a hallmark of quality education. 21 While there is a growing body of knowledge reported in the literature about these elements, a systematic aggregation of such evidence should identify implications for the educational and clinical faculties to develop appropriate and effective clinical training strategies and provide required support to the students. Our literature search has identified three reviews about student professionals’ learning experiences; however, these reviews have focused on the learning experiences of undergraduate nursing rather than midwifery students, 22 a setting other than clinical placements, 23 or the relationship between workplace culture and the practice experience. 24 This review addresses a gap in the literature by aggregating evidence about midwifery students’ perceptions and experiences of learning in clinical settings. The ultimate aim is to improve midwifery educators’ understanding of their students’ clinical experiences.

Review question

What are the perceptions and experiences of midwifery students’ learning in clinical practice?

Inclusion criteria

Participants.

This review will consider qualitative studies that focus on midwifery students’ perceptions and experiences of learning in clinical practice settings. There will be no limitation regarding age, gender, grade or year, or ethnicity of participants.

Phenomena of interest

The phenomena of interest will be midwifery students’ perceptions and experiences of learning in clinical practice settings.

This review will consider studies conducted in any settings identified as a clinical practice, including clinical placement or internship, in acute care, community care, or simulated learning environments.

Types of studies

This review will consider English-language qualitative studies that describe the perceptions and experiences of midwifery students in their clinical practice. These studies will focus on qualitative data including, but not limited to, designs such as phenomenology, grounded theory, ethnography, and action research. Qualitative data from mixed method studies will also be included.

The proposed systematic review will be conducted in accordance with the JBI methodology for systematic reviews of qualitative evidence. 25 The review has been registered in PROSPERO (CRD42020208189).

Search strategy

The search strategy aims to locate both published and unpublished studies. A three-step search strategy will be utilized in this review. An initial limited search of PubMed will be undertaken followed by analysis of the text words contained in the titles and abstracts, and of the index terms used to describe the articles. This preliminary search in PubMed will be used to develop a search strategy for this review that will include other databases. A second search using identified keywords and index terms will then be undertaken across all included databases. Thirdly, the reference list of all identified reports and articles will be searched for additional studies. A sample search strategy for PubMed is detailed in Appendix I. There is no date limit for the studies included in this review.

The databases to be searched for published studies include: MEDLINE (PubMed), Science Direct, Web of Science, EBSCO (CINAHL), and EBSCO (PsycINFO). The search for unpublished literature will include Google Scholar, American Nurses Association, ProQuest Dissertation & Theses Database, and Index to Theses in Great Britain and Ireland.

Study selection

Following the search, all identified citations will be collated and uploaded into EndNote v.9 (Clarivate Analytics, PA, USA) and duplicates removed. Titles and abstracts will then be screened by two independent reviewers for assessment against the inclusion criteria for the review. Potentially relevant studies will be retrieved in full and their citation details will be imported into the JBI System for the Unified Management, Assessment and Review of Information (JBI SUMARI; JBI, Adelaide, Australia). 26 The full text of selected citations will be assessed in detail against the inclusion criteria by the two independent reviewers. Reasons for exclusion of full-text studies that do not meet the inclusion criteria will be recorded and reported in the systematic review. Any disagreements that arise between the reviewers at each stage of the study selection process will be resolved through discussion or with a third reviewer. The results of the search will be reported in full in the final systematic review and presented in a Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) flow diagram. 27

Assessment of methodological quality

Papers selected for retrieval will be assessed by the two independent reviewers for methodological quality prior to inclusion in the review using the standard JBI critical appraisal checklist for qualitative research. 25 Any disagreements that arise between the reviewers will be resolved through discussion or with a third reviewer. Authors of primary studies will be contacted with questions on missing information or if clarification is needed. The results of the critical appraisal will be reported in narrative form, as well as in a table. All studies, regardless of the results of their methodological quality, will undergo data extraction and synthesis.

Data extraction

Qualitative data will be extracted from studies included in the review by the two independent reviewers using the standardized JBI qualitative data extraction tool for qualitative evidence (JBI SUMARI). The data extracted will include specific details about the participants, context, geographical location, study methods, and the phenomena of interest relevant to the review question and specific objectives. Findings will be verbatim extractions of the authors’ analytic interpretations, along with relevant illustrations. Each finding will be assigned a level of validity or credibility. Findings will be described as “unequivocal” or “credible,” as recommended in the JBI Manual for Evidence Synthesis . 25 All “unsupported” findings will be excluded from the review. Any disagreements relating to credibility that arise between the reviewers will be resolved through discussion or by a third reviewer.

Data synthesis

Qualitative research findings will, where possible, be pooled using JBI SUMARI with the meta-aggregation approach. 28 This will involve aggregation or synthesis of findings to generate a set of statements that represents the aggregation, through assembling and categorizing these findings on the basis of similarity in meaning. These categories will then be subjected to a meta-synthesis in order to produce a single comprehensive set of synthesized findings that can be used as a basis for evidence-based practice. The categories and synthesized findings will be agreed by discussion among the reviewers to ensure they support the meaning of the data. Where textual pooling is not possible, the findings will be presented in narrative form.

Assessing certainty in the findings

The final synthesized findings will be graded according to the ConQual 29 approach for establishing confidence in the output of qualitative research synthesis and presented in a Summary of Findings. The Summary of Findings includes the major elements of the review and details how the ConQual score is developed. Included in the Summary of Findings will be the title, population, phenomena of interest, and context for the specific review. Each synthesized finding from the review will then be presented along with the type of research informing it, score for dependability and credibility, and the overall ConQual score.

Acknowledgments

The library staff at Southern Medical University for their guidance and support on literature retrieval.

Appendix I: Search strategy

Medline (pubmed).

Search conducted August 2020

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Midwifery Dissertations: Choosing a Good Topic

The right topic for a dissertation is always a hard choice to make. Your midwifery dissertation is not an exception. Since you are not writing a midwifery essay that can be prepared in a couple of hours, you have to take the choice of a topic seriously.

In this article, you will find a short list of possible topics to cover in midwifery dissertations. Before that, we want you to read and consider some basic rules of selecting a topic for a midwifery dissertation.

Make sure you are going to research something really important. Midwifery is about dealing with people and being near in the most significant periods of their lives. Thus, your midwifery dissertation should be devoted to some acute problems that midwives and their patients might face.

Be specific and do not pick broad issues to discuss in your midwifery dissertation. Even if the issue you have chosen seems to be too narrow, it will transform and expand in the process of writing and researching.

Now, let us give you a couple of specific topic ideas for your midwifery dissertation.

Midwifery in the United States and other Western countries

In your midwifery dissertation, you may compare American midwife practices to those in other developed countries.

Home birthing and the role of midwives

Giving birth to a child is very different from that in a hospital. Tell in your midwifery dissertation about the peculiarities of home birthing, the role of a midwife, possible risks, etc.

Male midwives

This is a really interesting issue to investigate in the midwifery dissertation, since men are not that frequently involved in this field.

You are a novice dissertation writer, which means you need additional dissertation help. Our next article is devoted to some peculiarities of a dissertation research process.

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Interesting 40+ Midwifery Dissertation Topics for Students

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What Do You Understand by Midwifery Dissertation?

How to choose midwifery dissertation topics, latest midwifery dissertation topics 2024, trending midwifery dissertation topics 2024, midwifery dissertation literature review help, how our professionals can help.

Students are pursuing their studies in midwifery with the primary motive of gaining knowledge. Getting subject expertise requires hard work and concentration. Apart from that, students need to conduct a self-evaluation to examine their performance and progress. But talking specifically about midwifery dissertation topics, it offers a different range of research opportunities to explore maternal and newborn care. The term midwifery means it is a health profession that comes with the care of mothers and the various stages of pregnancy, childbirth, and the early postnatal period. To know more, read the information given in this blog, as it will tell you everything you need and will remove your query. Can anyone help me write my dissertation?

Midwifery refers to the healthcare of childbearing women and infants from pregnancy to post-birth. Where child protection during the pregnancy period is vital, maternal healthcare is also necessary. You can even use references from midwifery dissertation ideas to get clarity. 

When it comes to writing a lengthy document on midwifery, it allows researchers and doctors to find ways to avoid maternal and infant mortality. Therefore, medical students must choose good midwifery dissertation topics in their academics and dissertation modules. Now that you have understood the meaning, let’s move on to the next section on how you choose such topics.

Many students face difficulty pursuing their studies in midwifery. Like any dissertation, it is tough to choose a topic and write about it. Midwifery dissertation topics give you the same feeling at times. It is not an exception. However, you must know the essential areas for selecting the topic for the dissertation. Therefore, first to last topic selection, read some of the tips that can help you on how to write a midwifery dissertation. The tips are as follows:

• You need to be sure of the focal point you will discuss and elaborate on the topic throughout the whole document. It will help you with topic selection in a better way.
• You can even look at the midwifery dissertation examples to take reference and get the basic idea. The examples will give you an idea of how you can choose a topic to minimize the hurdles.
• The midwifery dissertation must convey and focus on the serious problems faced by mothers and newborns. So you must choose a topic around that only.
• You need to ensure that dissertation topics in midwifery are specific and not too broad. In the topic selection process, you need to determine how much you can elaborate on and provide information.
• If you have chosen a narrow topic, you must broaden the field of research and writing. In this type of dissertation, research is a core element. So regarding it, you need to do proper research so that while writing, you don’t face any problems.
• Must give proper attention to traditional midwifery dissertation ideas about the topics to know the content flow and scope.
• The midwifery dissertation topics should aim to explain the profession in depth. It should define the focal point rather than going off track.
• Try to enhance your basic knowledge to understand the subject better. Knowledge is a core element because, without it, you cannot write and develop your thought process. You can even refer to midwifery dissertation titles.
• You can choose a topic on maternal health care and their infants. These types of topics are generic and descriptive. You can choose your topics around these terms to make the process easier.

Now that you have understood how to choose midwifery nursing dissertation topics. Let's explore the best topics that you can get the idea from. Therefore, these can be the topics of nursing also. You can also get assistance from  nursing dissertation help  for your convenience.

We have listed some of the latest dissertation topics in midwifery to help you find good topics relatable to your research. Read the topics carefully and understand how they can benefit you in the topic selection process.

• The Adverse cause of recurrent miscarriage
• The cultural perspective on male midwives 
• How practical are the WHO perinatal recommendations?
• Role of DNA testing in diagnosing a child's hereditary condition
• Trends involving males who work as midwives
• Elaborate on Surgical success in treating an umbilical hernia
• What are the hereditary factors that contribute to miscarriage?
• The significant importance of eating well and being nourished when pregnant
• Treatment for a ruptured hernia
• Midwives' treatment of postpartum depression
• Perinatal treatment for disabled women
• Miscarriages' underlying mechanisms
• What is the difference between pregnant women's expectations and birthing experiences?
• What dangers lurk in-home abortions?
• Techniques for promoting a normal birth during the second stage of labor
• Why do umbilical cord hernias occur?
• What part do infections play in miscarriages?
• The right to pick one's birthplace
• Management of perinatal depression
• Obese women are still able to give birth typically, right?
• Describe the variables that prevent natural birthing.
• Taking care of hepatitis B while pregnant

Selecting midwifery dissertation topics from the mentioned examples helps and makes your efforts countable. When you finish the deep analysis, our professionals have drafted these ideas for you to save time. You need to pick the topic that interests you and begin working on it. Therefore you can also get  dissertation help  from experts for your convenience. If you still feel 23 topic ideas are not enough, below are some more topics to take help from.

Also Read:  Mental Health Dissertation Topics

It is understandable how difficult is to research a specific topic for dissertation writing. We have a qualified team of expert writers with good experience to give you some of the trending midwifery dissertation topics. It will give a basic idea of the current issues happening in the midwifery field.

• Uses, expectations, perspectives, and experiences with birth plans
• What causes pregnancy fear, and how can midwives help women?
• Nurses and midwives manage hypoglycemia in healthy-term newborns
• Midwife experiences with asylum seekers' maternity care
• Pregnancy, childbirth, and IPV relationships
• Increasing normalcy with midwifery care: aquatic births
• During the postnatal period, it reduces pain and infection and promotes healing of the sutured perineum
• Fathers' postnatal depression
• Antidepressants and postnatal depression
• Enhanced maternal safety in the Philippines
• Pediatric, obstetric, and clinician-indirect home interventions for the Medicare population
• A comprehensive assessment of the qualitative literature on the experiences of health workers in acute hospital settings with teamwork education
• How have "care pathway technologies" affected integrating services in stroke care?
• How strong is the evidence for their success in this area?
• Our nation has a midwifery culture
• Midwives have experience with difficult deliveries
• Knowledge of gender in midwifery
• Early midwives among the Native Americans: The art of midwifery
• Midwifery trends happening in the nursing practice
• What role does midwifery play in society?
• A comprehensive assessment of the experiences of midwives and nurses working together to offer childbirth care
• Relationship between women and midwives and childbirth education in your nation.

These interesting midwifery dissertation topics can impress your professors and will give you quick approval as professionals choose them personally. So if you face issues while writing a dissertation you can linger upon it by taking professional assistance and giving all your worries to the professional's.

Also Read:  Quantity Surveying Dissertation Topics

Writing a midwifery dissertation is similar to a doctoral-level dissertation. Moreover, the area of study is highly competitive, and often it is a little time-consuming. Talking about midwifery dissertation topics it consists of dissertation literature segments also.

Choosing the Right Research Materials 

When you are ready to start writing your dissertation, you require assistance from different areas to ensure to write the content properly. You need help to find the correct research materials can be online references or online libraries.

The Professional Editor Assistance 

Finally, your next area of help will be with the assistance of an expert editor; however, taking help from them will be the best. They will be checking your grammar and spelling, as well as analyzing your argumentative choices.

If you do not understand how to research Midwifery dissertation topics, you can also take the help of experts.

Women's Physicians Group

The advisors will be more interested than willing to assist in your writing tasks. Another source of advice in your midwifery dissertation literature review help is the women's physician's group. It is a group of female physicians before they entered medical school and is specifically for women in the medical field.

Do you want to expertise in midwifery or need assistance with medicine nursing dissertation topics? We have a skillful team of experts to help you and can write your dissertation with 100% quality and accuracy.

As a nursing and midwifery student, you may need a dissertation written by an expert writer. Furthermore, it might require giving a  dissertation structure  and writing a dissertation proposal. We can give you all the essential steps to give what you need. It requires a lot of concentration. That is why you can get help from a professional writer who can complete your dissertation on time.We can give you all the essential steps to give what you need. Talking about choosing midwifery dissertation topics is not an easy job.

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Disclaimer: This dissertation has been written by a student and is not an example of our professional work, which you can see examples of here .

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Midwife Experiences of Maternity Care for Asylum Seekers

Info: 10937 words (44 pages) Dissertation Published: 22nd Feb 2022

Reference this

Tagged: Nursing Health and Social Care Healthcare Midwifery

Purpose: The purpose of this dissertation is to investigate midwives’ experiences of providing maternity care to women seeking asylum. This dissertation concentrates on the experiences and view of midwives and women to determine areas requiring development and improvement.

Method: A systematic literature review of databases British Nursing Index, Cumulative Index to Nursing and Allied Health Literature, PubMed, MEDLINE, Cochrane Library. Inclusion and exclusion criteria were applied to narrow the search results. Five Key papers were identified and critiqued using the Critical Appraisal Skills Programme.

Findings: Midwives felt unprepared to support these women in a culturally appropriate holistic way. Training, advice and support was lacking and that which was received was often outdated and inconsistent, resulting in many women accessing care later in pregnancy, sometimes not until the point of delivery

Conclusions: Women seeking asylum during pregnancy need to be able to access holistic care and support earlier in their pregnancy to improve outcomes. The barriers faced by these women are contributing to traumatic negative experiences leaving them feeling unsupported, ignored, traumatised. Midwives need to be able to access up to date information about rights, entitlements, communication methods and other support to provides holistic care to these already vulnerable women.

Contents                                                                 

Chapter 1: Introduction………………………………………………………   Page 5

Chapter 2: Methodology…………………………………………………….   Page 7

Chapter 3: Critical Review………………………………………………….   Page 10

3.1 Barriers to communication……………………………………………   Page 10

3.2 Barriers to the access of maternity care……………………………   Page 15 

Chapter 4: Service Improvement…………………………………………     Page 19

4.1 Aim……………………………………………………………………….     Page 20

4.2 Measures…………………………………………………………………    Page 20

4.3 Ideas………………………………………………………………………    Page 21

4.4 Plan, Study, Do, Act cycle…………………………………………….    Page 22

4.5 Conclusion………………………………………………………………    Page 23

Reference list…………………………………………………………………    Page 24

Appendix 1 ………………………………………………………………….     Page 32

Appendix 2 …………………………………………………………………      Page 33

Appendix 3 …………………………………………………………………     Page 34

Introduction

The refugee council (1951) define a refugee as “a person who owing to a well-founded fear of being persecuted for reasons of race, religion, nationality, membership of a particular social group or political opinion, is outside the country of his nationality and is unable or, owing to such fear, is unwilling to avail himself of the protection of that country; or who, not having a nationality and being outside the country of his former habitual residence as a result of such events, is unable or, owing to such fear, is unwilling to return to it.”

Pregnant women seeking asylum in the United Kingdom have been recognised as a group of vulnerable women, as identified in the confidential enquiry into maternal and child health (CEMACH, 2011). They often face complex social factors, Poor maternal health and undiagnosed medical and mental health conditions and additional need in pregnancy (NICE, 2010), Much of this relates to suffering from the physical and psychological effects of fleeing from persecution and traumatic circumstances.

All women seeking or granted asylum in the UK are entitled to receive free maternity care. However, there are many barriers preventing this disadvantaged group from accessing and participating with maternity services. These include, communication (RCOG, 2010), knowledge of the NHS and entitlements (Department of Health, Social Services and Public Safety of Northern Ireland, 2004), dispersal by the United Kingdom border agency (UKBA) (Feldman, 2013), and cultural differences and discrimination (Tobin, Murphy-Lawless and Beck, 2013)

Simultaneously midwives providing care are also face challenges such as the complexity of the asylum system and legislation, Lack of training in cultural awareness, poor communication skills, insufficient time and access to interpreters. Midwives describe the care they provide as Substandard and unsatisfactory.

In (2010) the National Institute for Health and Care Excellence (NICE) implemented guidelines which aimed to improve maternity services for women with complex social factors. Woman centred care holistic approach was promoted. However, seven years later asylum seeking women’s needs are not being met. Poor antenatal care and communication difficulties are impacting on their experiences. The (2010) nice guidelines recommended training for midwives to improve their understanding of asylum seekers specific needs and how to meet them. However, the 2015 government spending review cut the Department of Health budget for non frontline services including medical by 1.5 billion. The evidence suggests there are inadequacies in care. This dissertation aims to review and critique the most current research and will conclude with a recommendation for achievable and sustainable service improvement.

Methodology

This chapter aims to look at the approach used to complete a thorough systematic critical literature review. Rees (2011, p77) states “A review of the literature is the systematic and critical examination of a defined selection of published literature on a particular topic or issue”. Research is a means of assessing and evaluating what we do as midwives, and in order to complete this, midwives are required to be able to appraise and synthesise the research available and evaluate evidence about the effectiveness of their practice and healthcare interventions (NMC, 2008)

The approach used to achieve a systematic review was to identify a topic of interest and understand the issues surrounding it. Before a search of databases was performed I began by looking into the availability and experiences of access to maternity care for pregnant women seeking asylum in the UK. Through this initial search I found some organisations and secondary sources of information. Among these were UK border Agency, Asylum Aid, Maternity Action, UK Government Asylum Support, City of Sanctuary and the Royal College of Obstetrician and Gynaecologists (RCOG). These sources assisted my wider reading and understanding around the topic. They enabled me to look at the policies and guidelines which provide instruction to those caring for women seeking asylum in pregnancy from border agencies to health care practitioners and have allowed me to assess the care being provided and delivered.

A mind map was produced to to allow exploration of the topic and clarify the issues and my personal understanding at this point. (Appendix 1) The next step was to perform an online search of The University of the West of England (UWE) library using the phrase ‘asylum seekers experiences of accessing maternity care’ this returned 869 results. Refining the search to peer reviewed and full online text reduced the results to 179. By further restricting the filters to the last 5 years and peer reviewed returned 82 results.

To help to identify further appropriate research papers a literature search strategy table was produced (Appendix 2) using synonyms this identified key search terms to be used in database searches. Databases relevant to the question and health and social care were searched including OVID maternity and infant care a key information resource used by maternity health care professionals and student midwives worldwide to support their research, BNI, PubMed, Psycinfo, science direct, CINAL and The Cochrane Library all of which are recommended by the RCM (2014)

The following Key terms were used interchangeably to investigate the objectives of the literature review; ethnic minorities, Asylum seeker, refugee, experiences, barriers, obstacles, feelings, maternity, care, access, antenatal, postnatal, labour, pregnancy and birth. Boolean operators (AND, OR) were used to define logical relationships between the search terms and refine the process (Bettany-Saltikov, 2012).Truncation* was used to search for all alternatives to words which are closely related, this ensured a through search of multiple forms of the key words (Rees, 201 1) The search also included the process of back chaining through a reference lists of relevant articles to search for other relevant primary sources ( Rees, 2015) Saturation was reached once no new articles were found (Polit et al, 2001).

Exclusion and inclusion criteria was also included in the literature search strategy table. Inclusion criteria included primary research which explored women’s experiences of access to maternity care in the UK whilst seeking asylum. This focused on qualitative research focusing on interviews, questionnaires and surveys. Inclusion also included Research which has been published and peer reviewed. Studies were excluded if they explored aspects other than women’s experiences to accessing maternity care during the asylum process or if they were not written in English. Exclusion also applied if they were from countries without a comparable demographic to the UK and Papers older than 10 years to ensure the evidence presented is the most up to date and related to practice (Moule and Goodman, 2014)

Five qualitative primary research studies were selected for critical analysis of the contents using the Rees framework for critiquing qualitative research tool (Appendix 3) (Rees, 2011) three themes stood out throughout the critical analysis of the papers. These are

• Communication
• Lack of cultural understanding

These will be explored in more detail in the next chapter.

Chapter 3 – Critical review

In 2010 the National Institute for Health and Care Excellence (NICE) published guidelines for antenatal care of women with complex social factors. The guideline acknowledges asylum seekers and refugees as one of the most vulnerable groups as identified in the Confidential Enquiry into Maternal and Child Health (CEMACH, 2011) report. The NICE (2010) guideline recommends asylum seekers and refugees should be provided with an interpreter (a link worker or advocate, not a family member) who can communicate in the woman’s preferred language.

This chapter will evaluate and synthesise the evidence of the two themes identified from the available evidence. ‘Barriers to communication’ and ‘Barriers to access of health care’. The themes will concentrate on how midwives can improve maternity care experiences for asylum seekers in the United Kingdom (UK).

3.1 Barriers to Communication

For those seeking asylum in the UK communication is one of the most challenging barriers (RCOG, 2010). Effective communication between midwives and women is essential, allowing the midwife to provide an individualised care plan, build a relationship and to provide healthcare promotion and education. According to Ameh and Broek (2008), good communication is the key to assisting midwives in improving maternity care and the lives of pregnant asylum seekers in the UK. Lyons (2008) suggests communication issues are the most common difficulty faced by midwives when caring for ethnic minority women. These women are not able to provide a full medical history, which results in inappropriate clinical decision-making and increased morbidity/mortality as recognised by the Mothers and Babies Reducing Risks through Audits and Confidential Enquiries (MBBRACE) 2015 report.

This theme will look at the barriers asylum seekers face when communicating with health professionals. Three studies were identified which all looked at the impact of communication and the barriers faced when communicating with health professionals whilst accessing maternity care. Philmore (2014), Feldman (2013) and Tobin and Lawless (2014).

Philmore (2014) undertook a qualitative mixed methods study which aimed to explore the reason new migrants do not access antenatal care. Non probability purposive sampling was used, this enabled the researchers to select women who had recently moved to the UK and utilised maternity services. A semi structured questionnaire was completed via interviews. When designing a questionnaire, the researcher should ensure that they are “valid, reliable and unambiguous (Zohrabi, 2013) . This was achieved through co designing the questionnaire with maternity professionals and migrant women. The study does not state if the maternity professionals involved in the design of the questionnaire are specialists within this area of maternity care, this would impact on the validity and reliability of the study.

82 questionnaires were completed respondents were identified through children’s centres and community groups, using a snowballing approach existing study participants recruit further participants from their acquaintances (Rees, 2012). This method would omit women from the sample who are isolated or who choose not to attend groups. The scale of coverage shows this method is more likely than other approaches to obtain data, based on a representative sample, therefore being transferable to a population. However, the data produced is likely to lack depth. The responses were themed using a systematic thematic analysis, enabling the researchers to move their analysis from a broad reading of the data towards discovering patterns and developing themes (Braun and Clarke, 2006).Thirteen women were then identified with different characteristics from the larger group. These women were asked to participate in, in depth interviews, the narratives provided data which matched and clarified the themes identified through the questionnaire.

Triangulation of the results was achieved through 18 in-depth interviews with maternity professionals, via email or telephone. This enabled the researchers to look at different perspectives and explore specific experiences. Rees (2011) states Triangulation permits the researcher consolidate and confirm the findings of the data collection, increasing the credibility and validity of the research . Polit and Beck, (2008) suggest ‘telephone interviews are a convenient method of collecting data if the interview is short, specific and not too personal. Nonetheless telephone interviews can be subject to interruption’s and loss of continuity, they also rely upon the midwife’s memory recall and small pieces of information which form the whole picture can be missed. The lack of visual cues via phone interviews results in a loss of context and compromises building rapport, probing and interpretation (Novick, 2008).

Ethical approval was given prior to the research study and Informed consent was achieved by discussing the nature and purpose of the study. Participants were given the opportunity to ask questions but the study does not specify if the participants were given the right to withdraw, how the information was anonymised, or how the data was secured. (Wood and Ross-Kerr, 2006) This would have would have strengthened the credibility of the study.

Philmore (2014)findingshighlighted a lack of inadequate interpreting and the use of family as interpreters.Philmore acknowledged women were failing to access maternity services because of their limited ability to communicate with midwives. They felt unsupported and vulnerable as access to language translation services was often poor and when available was associated with many issues which deterred its use. Interpreter services such as ‘Language Line’ and the ‘Big Word’ are frequently required but the services appear to be limited or unreliable in many areas, resulting in difficulty in accessing them. (Gerrish et al 2004; MacFarlane et al 2009; Hadziabdic et al 2010). Family were frequently used as interpreters, excluding women from conversations about their own care.

Feldman (2013)aimed to explore the experiences of asylum seeking women dispersed during pregnancy and the impact on their maternity care. The qualitative research used semi structured in-depth interviews. Semi structured interviews combine standard questions asked to all participants with the opportunity for the interviewer to explore the topic further, allowing for a richer in-depth data through spontaneity of both parties (Rees, 2011). The sample consisted of 20 women who had been dispersed or held in accommodation centres by the United Kingdom Border Agency (UKBA). Women were invited to participate through local refugee support organisations ensuring the sample was representative of the population required. Interpreters were provided to enable women with limited or no English to participate in the research when they may otherwise be excluded. Squires (2009) suggests Interpreters personal experiences can influence the way they translate and interpret the responses they receive. Some medical terminology can be difficult to translate into other languages, making it difficult to convey the meaning from one language to another. Therefore, the interpreter is not unbiased and this needs to be taken into account when analysis occurs (Temple, 2002).

Feldman (2013) study echoed Philmore (2014) who also interviewed midwives as part of the study. Interviews conducted via telephone, aimed to explore the midwifes’ experiences of caring for asylum seekers and refugees. The reliability of the interviews would be subject to similar themes as discussed previously leaving the validity of the results questionable. The reliability of study by Feldman (2013)could also be questioned as structured interviews are easy to replicate and quantify ensuring the results being reliable. However, there is no room for spontaneity from the participant and the data collected may not be as rich (Rees, 2011).

Feldman (2013)concluded failure to use interpreters added further stress, anxiety and burden on women. Therefore, maternity services are failing to meet the complex, health and social needs of these women. The NICE(2010) guidelines Pregnancy and complex social factors set out what healthcare professionals as individuals and antenatal services as a whole, can do to address these needs and improve pregnancy outcomes. The report highlights the extreme level of misunderstandings which, woman may face. The use of interpreters is crucial to supporting women and helping prevent their experiences from becoming traumatic and preventing future mental health problems

Tobin and Lawless (2014)undertook a qualitative study which aimed to explore midwives’ experiences of providing maternity care to women seeking asylum. A purposive sample of 10 midwives was selected. Purposive sampling can be used to produce maximum variation within a sample (Rees, 2011). This captures a range of perspectives allowing the researcher to identify common themes which are evident across the sample. It can provide bias results but the method aims to achieve the opposite by ensuring it provides the researcher with a detailed understanding of the person’s experiences. (Rees, 2011).

The sample of midwives in the study was small and therefore the findings could not be generalised. The findings do however provide an understanding of women’s needs which must to be met to improve the care midwives provide to this vulnerable population.The data was analysed using content analysis which reviews the narrative and identifies themes. This provided the researcher with an ecological validity as the participants are talking about their experiences and feelings, but this can be time consuming (Sutton and Austin, 2015). The researchers field notes and journals, offer an audit of decision making and allow the researcher to be conscious of their own bias, reactions and emotions to the data. Clinical supervision was used throughout and transcripts were examined by another researcher to confirm the findings. This ensures validity to the researcher.

Tobin and Lawless (2014) findings highlighted Language barriers as major cause for concern. Lack of access to professional interpreters caused a variety of problems. A reliance on family to interpret was emphasised as a problematic for both the midwives and the women. NICE ( 2010) recommend health professionals should be aware of the potential ethical and legal implications of their use. The use of family or friends as interpreters carries its own advantages, they are free, readily available and accessible and are familiar with the patient and their medical history (Phelan and Parkman, 1995). However, the woman’s confidentiality is compromised and this can leave her feeling vulnerable, embarrassed and uncomfortable. It can also have negative effects on relationships through misunderstandings, misinterpretation and the information can be adapted to suit the woman’s partner or family and support their agenda. This can impact upon the treatment and increase risks (Gerrish et al, 2004). Reliability to translate information correctly can occur, resulting in misconceptions of the information due to language barriers or dialect. This study was small and therefore cannot be generalised to the Larger population but could be transferable to another setting to allow findings to inform future provision of maternity care to asylum seekers (Polit and Hungler, 1997)

Philmore 2014; Feldman, 2013; Tobin and Lawless, 2014; studies all acknowledged communication as a barrier to asylum seekers and refugees accessing maternity care. Each study indicated the reoccurring vulnerability women felt due to the lack of accessible interpreters. This is confirmed by Ali and Burchett (2004) in their small scale qualitative research study investigating Muslim women’s experience of maternity services. Health professionals who participated in the focus groups identified communication as the most important barrier to providing effective maternity care. Philmore 2014; Feldman, 2013; Tobin and Lawless, 2014 similarly explored the experiences of midwives within their studies and all of these suggested that midwives are not always using interpreter services when communicating with asylum seekers and refugees, this was often due to the poor service, appropriateness of the service and lack of time and cost. Philmore and Feldman both used telephone interviews as a mean of obtaining data. therefore, compared to Tobin and Lawless (2014) the validity of their studies could be questioned, as the possibility of interruptions would be high consequently effecting the midwives recall of memory. The validity of all three studies would therefore be dependant upon the researcher and how they respond to the participants through their voice tones, emotion and body language (Anderson, 2010). Philmore (2014) used triangulation to combine interviews and questionnaire data, this addresses the issue of internal validity. Producing similar findings from different methods provides validation and assurance (Rees, 2011). The finding of all three studies do provide an insight into the communication barriers faced by asylum seekers and refugees accessing maternity care, it also gives food for thought about how these services need to be improved.

3.2 Barriers to the access of Maternity care

Asylum seekers and refugees face many complex social factors and additional need in pregnancy (NICE, 2010). These include difficulty accessing care and registering with health professionals, cultural differences, dispersal in pregnancy, discrimination and awareness of entitlements.

Tobin, Murphy-Lawless and Beck (2013) was a qualitative narrative analysis study using in-depth unstructured interviews. Unstructured interviews are particularly relevant in midwifery studies as they allow the participant voice to be heard and to gain an understanding of their perspective (Holloway and Wheeler, 2010) The aim of the study was to gain an insight into women’s experiences of childbirth in Ireland while in the process of seeking asylum. A purposive sample of 22 women was used these permitted researchers to select women who had experienced pregnancy and childbirth in the asylum process (Rees, 2011). Purposive sampling can be difficult to assess if the researcher has biased ideas about the participants (Bryman, 2012).The researcher must therefore rationalise how and why they have selected the participants (Burns, 2009). Ethical approval was obtained and participants were informed of the voluntary nature of participation and their right to withdraw at any time during the study. This ensures the safe guarding of vulnerable participants. The Nursing and Midwifery code (2015) stresses the importance of non maleficence and ensuring participants wellbeing during data collection. The Participants were reassured taking part in the study would in no way influence their application for asylum. Confidentiality was assured at every stage of the process, however there is no information about how the data was stored to protect the autonomy of the participants and ensure others did not have access to the data (Wood, and Ross-Kerr, 2006).

In-depth interviews took place in a variety of locations, this was decided by the participants. Allowing the participants to choose their environment ensures they feel comfortable, therefore allowing for richer data. Ensuring the reliability and validity of the study (Taylor et al., 2015). Interpreters were provided if required this echoed the study by Feldman (2013) which discusses the use of interpreters to allow all women to participate but talks about the way in which interpreters can influence the information in the way they translate and interpret the information. Therefore, effecting the validity and reliability of the study. Participants were engaged in the study over a period of three years and trustworthiness was assured through relationship building over this time period. Transcripts were returned to the participants for the purpose of editing or clarifying information. However, this can result in bias if the participant chooses to remove any valuable data effecting the reliability and validity of the study (Hagen, Dobrow and Chafe, 2009). Similar to the study by Feldman (2013) the researchers field notes and and journals, provided an audit of decision making and allowed the researcher to be aware of their own bias, reactions and emotions to the data. The transcripts were also examined by a second researcher experienced in analytical methods to confirm the findings and ensure validity of the data.

Tobin, Murphy-Lawless and Beck (2013) findings highlighted the medical model of care in the UK as a barrier to asylum seekers and refugees accessing care in the UK.  Women felt increased sense of fear, isolation and vulnerability. Women seeking asylum or refugee status are often not familiar with the westernised midwifery model of care and often come from cultures where there is a belief that medical care or intervention is only required when there is a problem and normally in their country care would only be accessed in labour (National collaborating centre for women’s and children’s health, 2010). It is important asylum seeking and refugee women are given information on how to access care and understand how care is organised and what to expect. NICE (2010) pregnancy and complex social factors guidelines offer advice and guidance to midwives on how to address these issues and improve pregnancy outcomes in this vulnerable group.

Tobin and Murphy-Lawless (2014) conducted unstructured in-depth interviews. The aim of the study was to explore Irish midwife’s experiences of providing maternity care to women seeking asylum. A purposive sample of ten midwives was drawn from two clinical sites. The purposive sample allowed the researcher to ensure the participants had experience of providing care to women in the asylum process, ensuring that the research returns relevant information and avoids wasting time, taking samples that have nothing to do with the topic (Rees, 2012).

Unstructured interviews were audio recorded and transcribed verbatim. Unstructured interviews allow the participant to express the important aspects of their experiences and elaborate on these, increasing the validity (McLeod, 2014). However, this requires skill from the researcher knowing when to probe, it also generates a lot of data to be analysed and coded, thus being time consuming and costly (Rees, 2012). All participants were informed about the voluntary nature of participation in the study. Assurance of confidentiality was given, ensuring the researcher does not allow unauthorised people access to the data (Burns and Grove, 2009). Informed consent was obtained from participants and ethical approval was granted through a local ethical committee. This ensures ethical principle are adhered to and and participants are protected from harm. Data was analysed using content analysis to identify prominent themes.

Tobin and Murphy-lawless (2014) Concluded the concept of cultural care as an emerging strong theme. Four midwives had received varying levels of training; some had received no training at all. The women had come from culturally diverse backgrounds but had been viewed as having the same needs and requirements. This led to feelings of ignorance and stigmatisation. The study further highlighted the need for improved education in cultural competency, an understanding of the asylum process and how to help and care for women who experience pre and post migratory stress. Horvat, Horey, Romios, Kis-Rigo (2014) suggest embedding cultural competence in healthcare systems enables systems to provide appropriate care to patients with diverse values, beliefs, and behaviours, including meeting patients’ social, cultural and linguistic needs.

Both studies recognised cultural customs and beliefs and the western medicalised model of care as a barrier to accessing maternity care. Asylum seekers and refugees are known to experience some of the worst maternal health outcomes in the UK (The Marmot Review, 2010; Henderson et el., 2013) Reducing health inequalities has long been at the forefront of public health policy in many countries including the United Kingdom (Department of Health, 2012). Both studies attempted to prove midwives endeavoured to provide women centred individualised care, through sensitively responding to the women’s needs. They found this challenging due to their cultural education, beliefs and understanding. However, conflicting expectations could adversely affect the relationship where cultural and religious practices are not understood or met (Aquino, Edge and Smith, 2014). Tobin and Murphy-Lawless (2014) further recommends an evaluation of the cultural competency education programme and training in Ireland.

Four papers critiqued within the literature review have highlighted two themes which could enhance access to maternity care for asylum seekers and refugee in the UK. Philmore (2014), Feldman (2013), Tobin and Lawless (2014) and Tobin, Murphy-Lawless and Beck (2013) all highlighted the need for cultural competency awareness, information, education and training for midwives. Therefore, this theme will be taken forward to chapter 4 to develop a Service Improvement Plan.

Chapter 4: Service Improvement plan

The five studies reviewed in chapter three highlighted the difference or lack of cultural training midwives had experienced even when working with women seeking asylum in pregnancy. Understanding the processes of asylum, women’s entitlements, cultural and linguistic barriers and support given by the midwives were all highlighted as inconsistent therefore preventing and discouraging these women from accessing maternity care. Midwives are the first point of contact, it is therefore vital they are able to provide culturally competent care free from feeling discriminated against, stigmatised and disregarded

It is vital to understand the barriers being faced by midwives and women and use this knowledge to adapt an approach relevant to the problem and implement change through a service improvement plan. It is important to set realistic goals and objectives and define how these will be achieved. Changes made must be measured to ensure they impact upon the service in a positive way (Batalden et al., 2007). Langley et el (2009) ‘Service Improvement (SI) model will guide this process. Langley’s model is divided into two sections. ‘Thinking’ part comes first and consists of three fundamental questions which are essential to guide the process. Then comes the ‘doing part’ this consists of the Plan, Do, Study, Act (PDSA) cycle which helps to make the changes which need to be addressed and implemented.

Stage 1 – Thinking

Initially we need to consider what are we trying to accomplish? The studies in chapter three highlighted women seeking asylum whist pregnant are disadvantage in comparison to other groups in pregnancy, Aspects including; communication difficulties, cultural difference, financial and complex social barriers and dispersal. (Feldman,2013) The research suggests this vulnerable group would benefit from cultural competency awareness, information, education and training for midwives to enable them to enhanced access to maternity care and improve their experiences.

The aim of this service improvement plan is to provide midwives with the skills and knowledge they need to support pregnant asylum seekers and refugees to access and receive woman centred individualised maternity care. To achieve this SMART (Specific, Measurable, Achievable, Realistic and time bound) objectives have been set;

• To create an information book (electronic and hard copy) for midwives which will set out information about the process of seeking asylum, rights, entitlements, support, contact telephone numbers and complex factors to consider and cater for when caring for refugees or women seeking asylum during pregnancy.
• The book will be distributed to all Bristol National Health Service (NHS) trusts for further dissemination to the trust dependencies.
• To be reviewed and audited using Langley (2009) PDSA cycle, every 6-12 months through questionnaires’, focus groups and and annual seminar.

4.2 Measure

To assess if the Service Improvement is successful measurement of change must occur before, during and after the task. This will provide a baseline to measure improvement against and ascertain if change is happening and if the change is making an improvement. (NHS Improvement, 2012). To achieve this current services will need to be reviewed and a baseline measures set out. Baseline measures will include;

• Number of refugees or asylum seekers midwives across Bristol trusts which midwives care for.
• Number of midwives across Bristol trusts who have knowledge (if any) of the process of seeking asylum, support services, entitlements and rights or complex social factors of the women.
• Measure the local mortality and morbidity rates for this group of women.

Post measures;

• Number of refugee or asylum seekers, midwives across Bristol trusts care for. (has this improved, are women finding access to care better)
• Have refugees or asylum seekers experiences of maternity care improved?
• Has the knowledge and understanding of midwives, about how to care for this group of vulnerable women improved?
• Has the local mortality and morbidity rates of this group improved?

To establish if the services midwives give to refugees and asylum seekers have improved their care reduced judgements, discrimination, anxiety and improved the midwife woman relationship will involve women giving feedback about their care. This could be achieved through a questionnaire similar to the current NHS initiative ‘Friends and family test (2012). This would involve all women receiving assessment questionnaires to complete via email or post. A disadvantage of this method would be the low response rate (Nakash et al., 2006) a questionnaire about the care and support they have received to gauge if they have benefited from the services. A questionnaire would need to be available in many different languages, dialect and wording would need to be considered so this may become a costly method of gaining feedback. Women centred small focus groups with an interpreter may prove to be a better option they have proved particularly good at those who are disadvantaged (The Health Foundation, 2013). This would allow for the women to comment of the services and their experiences and to help develop future improvement plans. However, these may not prove as efficient as individual interviews which would be timely and expensive (The Health Foundation, 2013)

The idea for the change is to improve the care, experiences and outcomes of refugees and asylum seekers through improved knowledge understand and training of the midwives caring for them. During the first year the book should be disseminated across Bristol trusts and their dependencies. This can be done electronically and via hard copy. A contact email for ownership of the document will be available for midwives using the document to communicate any known amendments or improvements they are aware of; this will provide version control of the service improvement being used.

4.4 Plan, Do, Study, Act (PDSA) cycle

Plan ; Online documents are often seen as good tools to implement changes in practice. The NHS Institute for Innovation and Improvement (2008) states to implement new changes in service delivery, it is important that pilot studies are undertaken. The document will provide a resources which can be easily updated, accessible and used over and over. When planning the Service Improvement, factors which will influence its success such as; professional’s awareness of the document, the format and layout of the document, the motivation of midwives to use the document, must be considered. Trust should promote the up coming document via the intranet and trust newsletters. Managers in trust dependency areas should deliver training on the book and discuss the use of it operation with their staff.

DO; When designing the document Trusts taking ownership must consider the use of focus groups, this should include specialists in the area of asylum, support services, midwives, and women who have received maternity care whilst in the asylum process. Thus ensuring the information within the book is up to date, relevant and useful. The document when finalised should be circulated around the focus group members for the purpose of editing and clarifying information and to ensure agreement on the final document. Inviting midwives to the participation of the design of the document will inspire them to feel ownership which will encourage the use of the document. This will improve the success of the implementation plan. Circulation of book should be done electronically and via hard copy allowing for easy and repeated use.

Study; six to twelve months after implementation of the document the focus group will need to come together to review it. This period of time will allow for the implementation of the document, its information and processes to be embedded into practice areas. After this time period analysis will occur. Staff involved in using the document will be invited to participate in the evaluation via questionnaires. Questionnaire’s are useful for evaluation of service improvement. The analysis of the questionnaire data would then be taken forward to an After Action Review (AAR) a tool used to facilitate assessments. The design focus group would come back together using the AAR tool to discuss the document, reflect upon how it has changed practice, evaluate the document, looking at how effective the document has been and if the document has led to positive changes making improvements in the service. (Cronin and Andrews, 2009).

Act; the next step is to continue to review the document on a regular basis to enable changes in practice and policy to be amended. The NHS institute for innovation and improvement (2008) states multiple cycles of the PDSA cycle are required to highlight adaptions which are profound after the first cycle. Providing further training to staff may be required, but this would be costly to the trust in terms of money and time.

4.5 Conclusion

In conclusion the experiences of pregnant women seeking asylum in the UK are poor. Midwives receive very little formal training in caring for this vulnerable group. Training is costly in money terms and time to NHS trusts. Midwives endeavour to provided women centred individualised care but find this challenging due to their lack of awareness of NHS entitlements, cultural training, personal beliefs and understanding. These experiences cause avoidance in interaction with maternity services resulting in poor outcomes and higher rates of morbidity and mortality. This service improvement plan was designed to meet the needs of midwives providing maternity care to pregnant women seeking asylum and also to improve the experiences of this vulnerable group of women. By considering the needs of the women and the Midwives caring for them holistically this document will improve the quality of the service provided and better equip the midwives to manage the service in an appropriate way.

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Planning Mind Map.

Ovid Maternity and Infant Care, MEDLINE, The Cochrane Library and ASSIA:

CINAHL Plus- I searched the four first words in each category as it only allowed twelve in the advanced search function.

PsycInfo- originally same words as those searched in CINHAL but because no relevant research appeared, only ‘maternity’, ‘experiences’, ‘asylum seekers’ and refugees were used.

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• Introduction to Academic Resources
• How to run your search
• Finding Books
• Finding Journal Articles
• Finding policy papers and other evidence sources
• Evaluating Health Sources
• Keeping track of your sources
• Writing and Referencing

Selected titles to help you write a literature review

Lterature reviews, tools to help you focus your topic, search strategy elements, research resources, full text not available.

Literature reviews have multiple purposes and can take many forms.  General guidance is below.

Often in healthcare and other fields, a systematic literature is expected. If so, see our specific guide:

• Systematic literature searching You might be an undergraduate who wants to improve the quality of their searches, a postgraduate deciding on a dissertation topic, or a PhD student conducting a systematic literature review as part of your thesis. Or, you might be a member of staff conducting systematic search as part of your academic work, grant application, or Knowledge Transfer Partnership (KTP) programme. This guide is your practical companion, offering insights and strategies to navigate the intricacies of systematic searching work.

There are several tools available to help researchers formulate a robust research question or hypothesis.  These may be helpful in refining your topic and developing a search strategy for your assignments.

Your search strategy incorporates all the decisions made while selecting items for your literature review.

Themes and keywords

• What are the separate elements of your topic/search? 
• Which are the principal key words or search terms for each element? 
• Are there obvious alternative search terms that should be included?  For example, 'international' could also be described as 'global' or 'worldwide'.

Your initial searches on the topic will help you ascertain relevant search terms.

• Which types of material are you including in your review?  This can be restricted to research articles or encompass policy papers, textbooks, reports, conference presentations, blogs and more.
• Which bibliographic resources are most relevant to your topic, and the types of material identified above?  Options include bibliographic databases and Google Scholar (journal and research papers); the library's OneSearch (books, exemplars and more), Google or other general search engines (policy papers, blogs ...).See Specialist Resources for links to CINAHL and other bibliographic services. 

Additional selection criteria

• Does a specific date range for publication apply? 
• Are you only interested in a specific scenario or environment?
• Are you focusing on a specific population?

Please remember:

• Your decision making will be influenced, in part, by the restricted nature of your assignment and related timescale.
• You will be accessing and reading multiple items for each assignment.  Some of these will be relevant throughout our programme, or in other contexts. See the Keeping Track of your Sources page on this guide for advice on noting details methodically.

Research methods

• UWS Library - Dissertation Support Our dedicated guide with help and support for each step of the dissertation process, including an introduction to literature reviews.
• UWS Library - Research Support UWS Library provides a selection of resources and support options to facilitate the research journey.
• SAGE Research Methods This link opens in a new window e-books, case studies, videos and data sets supporting the development of research skills more... less... Searchable via One Search. Use your student/staff email address and password to access the resource.
• Open Research Library This link opens in a new window The Open Research Library is a hosting platform for peer-reviewed, open access, scholarly monographs. Its aims is to include all OA book content worldwide on one platform for user-friendly discovery with a seamless experience. more... less... Not Searchable via One Search. No login required.

Open access resources

• CORE This link opens in a new window CORE is claimed to be a platform providing access to the world’s largest collection of open access research papers. Its mission is to facilitate free unrestricted access to research for all. more... less... Not Searchable via One Search. No login required.
• Open Access Button Search engine enabling free access to the full text of scholarly articles in compliance with copyright restrictions.

Systematic reviews

• Cochrane Library This link opens in a new window The Cochrane Library (ISSN 1465-1858) is a collection of databases, such as: Cochrane Database of Systematic Reviews (CDSR), Cochrane Central Register of Controlled Trials (CENTRAL), Cochrane Clinical Answers (CCAs) and a number of special collections. They contain different types of high-quality, independent evidence to inform healthcare decision-making. more... less... Not Searchable via One Search. All residents of Scotland can access the Cochrane Library for free, thanks to funding provided by NHS Education for Scotland.
• TRIP Medical Database TRIP is a clinical search engine designed to allow users to quickly and easily find and use high-quality research evidence to support their practice and/or care.

If the article, or book, is not available, see possible  External and Open Access options. 

Still no success?

Library staff may be able to obtain a copy for you - see our Inter Library Loan guide for details.

• UWS Library - Inter Library loans (ILLs) Our dedicated guide to help you make requests for access to books and journal articles held in the British Library or other (mainly UK) Library collections.
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What is a literature review?

Choosing a topic, developing your search strategy, carrying out your search, saving and documenting your search, formulating a research question, critical appraisal tools.

• Go to LibrarySearch This link opens in a new window

So you have been asked to complete a literature review, but what is a literature review?

A literature review is a piece of research which aims to address a specific research question. It is a comprehensive summary and analysis of existing literature. The literature itself should be the main topic of discussion in your review. You want the results and themes to speak for themselves to avoid any bias.

The first step is to decide on a topic. Here are some elements to consider when deciding upon a topic:

• Choose a topic which you are interested in, you will be looking at a lot of research surrounding that area so you want to ensure it is something that interests you. 
• Draw on your own experiences, think about your placement or your workplace.
• Think about why the topic is worth investigating.  

Once you have decided on a topic, it is a good practice to carry out an initial scoping search.

This requires you to do a quick search using  LibrarySearch  or  Google Scholar  to ensure that there is research on your topic. This is a preliminary step to your search to check what literature is available before deciding on your question. 

The research question framework elements can also be used as keywords.

• Think about who the population/ sample group. Are you looking for a particular age group, ethnicity, cultural background, gender, health issue etc.
• What is the intervention/issue you want to know more about? This could be a particular type of medication, education, therapeutic technique etc. 
• Do you have a particular context in mind? This could relate to a community setting, hospital, ward etc. 

It is important to remember that databases will only ever search for the exact term you put in, so don't panic if you are not getting the results you hoped for. Think about alternative words that could be used for each keyword to build upon your search. 

Build your search by thinking about about synonyms, specialist language, spellings, acronyms, abbreviations for each keyword that you have.

Inclusion & Exclusion Criteria

Your inclusion and exclusion criteria is also an important step in the literature review process. It allows you to be transparent in how you have  ended up with your final articles. 

Your inclusion/exclusion criteria is completely dependent on your chosen topic. Use your inclusion and exclusion criteria to select your articles, it is important not to cherry pick but to have a reason as to why you have selected that particular article. 

• Search Planning Template Use this template to plan your search strategy.

Once you have thought about your keywords and alternative keywords, it is time to think about how to combine them to form your search strategy. Boolean operators instruct the database how your terms should interact with one another. 

Boolean Operators

• OR can be used to combine your keywords and alternative terms. For example "Social Media OR Twitter". When using OR we are informing the database to bring articles continuing either of those terms as they are both relevant so we don't mind which appears in our article. 
• AND can be used to combine two or more concepts. For example "Social Media AND Anxiety". When using AND we are informing the database that we need both of the terms in our article in order for it to be relevant.
• Truncation can be used when there are multiple possible word endings. For example Nurs* will find Nurse, Nurses and Nursing. 
• Double quotation marks can be used to allow for phrase searching. This means that if you have two or more words that belong together as a phrase the database will search for that exact phrase rather than words separately.  For example "Social Media"

Don't forget the more ORs you use the broader your search becomes, the more ANDs you use the narrower your search becomes. 

One of the databases you will be using is EBSCOHost Research Databases. This is a platform which searches through multiple databases so allows for a comprehensive search. The short video below covers how to access and use EBSCO. 

A reference management software will save you a lot of time especially when you are looking at lots of different articles. 

We provide support for EndNote and Mendeley. The video below covers how to install and use Mendeley. 

Consider using a research question framework. A framework will ensure that your question is specific and answerable.

There are different frameworks available depending on what type of research you are interested in.

Population - Who is the question focussed on? This could relate to staff, patients, an age group, an ethnicity etc.

Intervention - What is the question focussed on? This could be a certain type of medication, therapeutic technique etc. 

Comparison/Context - This may be with our without the intervention or it may be concerned with the context for example where is the setting of your question? The hospital, ward, community etc?

Outcome - What do you hope to accomplish or improve etc.

Sample - as this is qualitative research sample is preferred over patient so that it is not generalised. 

Phenomenon of Interest - reasons for behaviour, attitudes, beliefs and decisions.

Design - the form of research used. 

Evaluation - the outcomes.

Research type -qualitative, quantitative or mixed methods.  

All frameworks help you to be specific, but don't worry if your question doesn't fit exactly into a framework. 

There are many critical appraisal tools or books you can use to assess the credibility of a research paper but these are a few we would recommend in the library. Your tutor may be able to advise you of others or some that are more suitable for your topic.

Critical Appraisal Skills Programme (CASP)

CASP is a well-known critical appraisal website that has checklists for a wide variety of study types. You will see it frequently used by practitioners.

Understanding Health Research

This is a brand-new, interactive resource that guides you through appraising a research paper, highlighting key areas you should consider when appraising evidence.

Greenhalgh, T. (2014) How to read a paper: The basics of evidence-based medicine . 5 th edn. Chichester: Wiley

Greenhalgh’s book is a classic in critical appraisal. Whilst you don’t need to read this book cover-to-cover, it can be useful to refer to its specific chapters on how to assess different types of research papers. We have copies available in the library!

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Literature review.

Midwifery students' experiences of learning to be ‘with woman’: a scoping review

This scoping review was conducted according to the Preferred Reporting Items for Scoping Reviews, as outlined by the Joanna Briggs Institute (Aromataris and Munn, 2020). A priori protocol was...

Breastfeeding knowledge assessment tools among nursing and midwifery students: a systematic review

This systematic review was conducted to identify tools that have been developed to evaluate breastfeeding knowledge and practice among nursing and midwifery students. The review followed the Preferred...

Impact of the midwife-led care model on mode of birth: a systematic review and meta-analysis

A systematic review is the best approach to determine the most effective intervention/treatment in clinical decision-making (Harvey and Land, 2017). This method follows explicit, rigorous and...

The role of egg consumption in the first 1001 days of life: a narrative review

For this narrative review, PubMed was searched to identify key articles published between 2019 and 2024 investigating egg consumption during pregnancy, breastfeeding and/or infancy. The following...

Autistic women's experiences of the antenatal, intrapartum and early postnatal periods

The PICO mnemonic (Stern et al, 2014) was used to identify key words and develop the research question: what can midwives in England learn from studies exploring the experiences of autistic women in...

Perinatal outcomes in persistent occiput posterior fetal position: a systematic review and meta-analysis

Meta-analysis is a quantitative, formal, epidemiological study design used to systematically assess the results of previous research to derive conclusions about that body of research (Haidich, 2010)....

Carbetocin vs oxytocin in third stage labour: a quantitative review of low- and middle-income countries

This review was carried out to determine if the use of carbetocin in low- and middle-income countries would reduce the risk of postpartum haemorrhage, and associated morbidity and mortality, in...

mHealth interventions to improve self efficacy and exclusive breastfeeding: a scoping review

The electronic search was carried out in September 2022, using the population/problem/patient, intervention, comparison, outcome and study design strategy. The primary source of literature was online...

The use of gender-neutral language in maternity settings: a narrative literature review

A preliminary search of the Cochrane Library, CINAHL, and MEDLINE databases was undertaken to identify articles relating to the topic. Search terms or text words contained in titles, abstracts and...

Midwives’ practice of maternal positions throughout active second stage labour: an integrative review

An integrative review was considered suitable for this study, as this methodology allows inclusion of data from all types of literature to fully answer review questions (Whittemore and Knafl, 2005;...

Health-seeking behaviours of pregnant adolescents: a scoping review

This study was developed based on Arskey and O'Malley's (2005) scoping review methodology. According to this framework, there are six stages: (1) identifying the research question, (2) identifying...

Maternal intrapartum fluids and neonatal weight loss in the breastfed infant

Searches of key databases (CINAHL, MEDLINE, EMBASE, EMCARE) were conducted using a search strategy developed in collaboration with the local NHS library service (Table 1). Known researchers in this...

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Midwifery: Forming Questions

• Getting Started
• Forming Questions
• Search/Research
• Entry to Practice Resources

A Good Question...

• Focuses your information needs
• Identifies key seach concepts
• Points you in the direction of potential resources

Background Questions

These questions are general in nature and provide foundational information on a single concept. Background questions cover topics including:

• Terminology
• Health Promotion
• General Drug Information
• Midwifery Interventions

What are some examples of culturally rooted birthing practices ?

What drugs are used to treat hypertension ?

What types of education resources exist for mothers with gestational diabetes ?

How is sepsis  diagnosed?

What does fetal heartbeat  sound like?

Answers to these questions may be found in text-book like resources, handbooks, manuals, and in resources providing overviews.

Online Resources

• The Well Built Clinical Question Duke University Medical Center Library and Health Sciences Library
• Focusing Clinical Questions Centre for Evidence-Based Medicine, Oxford

Foreground Questions

These questions bring together multiple concepts related to a specific clinical situation or research topic.  They are typically divided into two categories:

• Qualitative Questions  aim to discover meaning or gain an understanding of a phenomena.  They ask about an individual's or population's experience of certain situations or circumstances
• Quantitative Questions often  aim to discover cause and effect relationships by comparing two or more individuals or groups based on differing outcomes associated with exposures or interventions.

These questions are often best answered using the resources found in the 6S Pyramid.

Forming Foreground Questions

Building an effective foreground question can be challenging.  The following models will help:

Qualitative Questions: The PS Model

P - Patient/Population

S - Situation

How do/does ___ [P] ____ experience _____ [S] _____?

Ex. How do mothers with a detailed birthplan  experience deviations from this plan ?

___________________________________________________________________________

Quantitative Questions: The PI/ECO(T) Model

A quantitative approach can answer many different types of questions, but all can be formatted by following the  PI/ECO(T) Model  outlined below:     

PICO(T) Templates

In ___ [ P ]___,  do/does ___[ I ]___ result in ___[ O ]____ when compared with ___[ C ]___ over ___[ T ]____?

E.g.) In infants unable to latch for breastfeeding , does prompting through  finger feeding  result in a higher rate of latching   when compared with prompting through bottle feeding over the first year of life ?

Are ___[ P ]___  with  ___[ I ]___  over ____[ T ]____ more likely to ___[ O ]____ when compared with ___[ C ]___ ?

E.g.) Are mothers  given cesarian sections in their first pregnancy  more likely to experience uterine rupture during subsequent pregnancies  when compared with first time mothers giving vaginal birth ?

Is/are ___[ I ]___ performed on ___[ P ]___   more effective than ___[ C ]___  over ___[ T ]____in ___[ O ]____?

E.g.) Is transvaginal ultrasound  performed on expectant mothers  more effective than laparoscopy   in  diagnosing ectopic pregnancies ?

In ___[ P ]___,  do/does ___[ I ]___ result in ___[ O ]____ when compared with ___[ C ]___ over ___[ T ]____?

E.g.) In  women experiencing their first pregnancy , do   pregnancy-tracking mobile apps  result in  fewer unneccesary hospital visits  when compared with self-tracking  over the course of the pregnancy ?

Do/does ___[ I ]___ for/performed on ___[ P ]___   lead to  ___[ O ]___  over ___[ T ]____compared with ___[ C ]____?

E.g.) Do Mommy-and-Me programs for  first time mothers   lead to  quicker return to pre-pregnancy body image    over the first year of motherhood  compared with no intervention ?

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• Last Updated: Jul 30, 2024 9:03 AM
• URL: https://hslmcmaster.libguides.com/midwifery